ARTICLES
Informant Disagreement for Separation Anxiety Disorder

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ABSTRACT

Objective

To characterize informant disagreement for separation anxiety disorder (SAD).

Method

The sample comprised 2,779 8- to 17-year-old twins from a community-based registry. Children and their parents completed a personal interview about the child's psychiatric history. Parents completed a personal interview about their own psychiatric history and a questionnaire about their marital relationship.

Results

Informant agreement for SAD ranged between chance and extremely poor. Most cases of SAD were diagnosed by interview with only one informant. SAD diagnosed only by child interview was associated with an increased odds of father-rated oppositional defiant disorder, and vice versa. SAD diagnosed only by parent interview was predicted by the parental informant's history of antisocial personality disorder. SAD diagnosed only by paternal interview was also predicted by mother-rated marital conflict and dissatisfaction.

Conclusions

Parents and children rarely agree about the presence of any level of child separation anxiety. A symptom “or-rule” mostly indexes diagnoses based on interview with only one informant, but the relative validity of such diagnoses remains unclear.

Section snippets

METHOD

Subjects were participants in the Virginia Twin Study for Adolescent Behavioral Development (VTSABD). The VTSABD is a longitudinal community-based study of 1,412 Caucasian families with 8- to 17-year-old juvenile twins (Eaves et al., 1997; Hewitt et al., 1997). Twins were eligible for the current study if the twin, mother, or father was interviewed about the twin's history of SAD at entry to the study. The eligible sample comprised 2,779 individual twins (1,280 boys and 1,499 girls).

Families

RESULTS

Child interviews identified more cases of SAD than parent interviews (Table 1). Between 30% and 50% of cases had some degree of associated impairment. The female-to-male ratio of cases was higher based on parent (especially paternal) interview. The prevalence of SAD declined in association with increasing age, but age trends were statistically significant only for cases diagnosed by the or-rule or child interview. Pubertal status was associated with SAD in girls after partitioning out the risk

DISCUSSION

SAD is a relatively common disorder based on child interview or an or-rule, but SAD is a relatively uncommon disorder based on parent (particularly paternal) interview or in association with any degree of functional impairment. Girls are more likely to be diagnosed with SAD than boys, but this sex difference is more pronounced based on parent (especially paternal) interview. The prevalence of SAD peaks in younger children, but child interviews index more age-related variation than parent

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    This work was supported by NIMH grants MH-60324, MH-45268, MH-57761, and MH-65322 . The authors acknowledge the contribution of the Virginia Twin Study for Adolescent Behavioral Development, now part of the Mid-Atlantic Twin Registry (MATR), to ascertainment of subjects for this study. The MATR, directed by Drs. Corey and Eaves, has received support from the NIH, the Carman Trust for Scientific Research, and the WM Keck, John Templeton, and Robert Wood Johnson Foundations.

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